This blog chronicles my experiences working and living in Rwanda. The contents of this website are mine personally and do not reflect any position of the U.S. government, the Peace Corps, Emory University, the Rwanda Zambia HIV Research Group, or any other organization with which I am affiliated.

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Wednesday, June 24, 2015

From originating couples’ testing a standard of care to
initiating HIV vaccine research in Rwanda, PSF has a habit of breaking
ground.I guess it shouldn’t be a
surprise that Rwanda’s first-ever survey of MSM* was also conducted by PSF just
this past year.I’m beyond excited.While I’m not directly involved in the MSM
study, I’m extremely proud to be working with an organization that is engaging
with LGBTQ health in Africa.It’s a difficult
subject, one fraught with political peril, and something I’ve been interested
in since I was undergraduate.

In the countries surrounding Rwanda, same-sex sexual
activity is punishable by several years’ imprisonment, life imprisonment,
corporal punishment, or death.By
contrast, the Rwandan government has not created any legislation explicitly
criminalizing homosexuality.Instead,
the official policy is one of complete denial.When PSF approached the Rwandan Biomedical Committee with their proposal
for MSM research, they were given permission to proceed, but they were also
laughingly told that they wouldn’t find any MSM in Rwanda.Since then, more than 1,000 men have been
interviewed and about 400 study participants have been enrolled. The goal of the study is just to get a handle on MSM networks and health behaviors while providing STI testing and some basic health services, but it will serve as groundwork for broader initiatives in the future.

I knew the study was going on but I didn’t meet the MSM
research team until just last week.The
founder of PSF arrived from Zambia to check on our progress and brought with
her a young man I’ll refer to as David.David is a Zambian activist for LGBTQ rights.He works with an NGO that promotes LGBTQ
health and supports what he referred to as the “rainbow platform,” candidates
who run for public office in Zambia with the explicit intent to de-criminalize
homosexuality nationwide.The night he
arrived we all had dinner – him, the MSM study team, the founder of PSF,
several other senior staff, the other summer interns and myself – and we talked
uninhibited about our mutual ambition to bring the issue of LGBTQ health to
light in southeastern Africa.As Peace
Corps Volunteer, I sat on my opinions about homosexuality for fear of
alienating myself from people in my village.Talking to David, I felt as if five years’ worth of weight was being
lifted.

Before leaving PSF the following Thursday, David made a
small speech to express his thanks.He
said he had come to Rwanda to learn how PSF is engaging with the issue of LGBTQ
stigmatization and persecution and that he is excited by the work we are
doing.He said, “In Africa, many people
think that the HIV epidemic can be stopped by simply treating members of the ‘general
population’ – the heterosexual population – and that the rest of us can be
ignored because we are a minority. But the situation is more fluid than that.
There are married men who are also members of our community.There are people who move in and out of our
community.We are not an isolated group –
we are part of the population too, and if you don’t attend the needs of MSM and
other LGBTQ people, you may as well do nothing at all.”

I couldn't have said it better.

*MSM stands for “men who have
sex with men.” While the terms “gay” and “homosexual” may be commonplace in the
U.S., such terms carry little meaning in countries where homosexuality is
neither condoned nor acknowledged, and where gay culture and networks remain
thoroughly underground.Furthermore, in public
health research, sexual behaviors often take primacy over how a person identifies
because behaviors directly cause things like the transmission of HIV.

Monday, June 15, 2015

This summer I’m sharing a PSF-owned house with two other MPH
students, Kristina and Tiffany, and a fourth-year med student, Eli.We recently received another housemate,
Bromley, whose dad used to work in administration with PSF.She’s only sixteen, but thanks to her family
contacts and a lot of gumption on her part, she is building her nascent resume
at Rwandan clinics. She says she wants to get her MPH someday.I don’t think she’s going to have any trouble
doing so.

Eli is a new addition to our group – he only arrived this
week – but the rest of us have become a pretty tight team, especially when it
comes to planning our weekends.So far
we’ve explored Volcanoes National Park, braved the open-air market at
Kimironko, and sought out Kigali’s best restaurants.This past weekend, though, was a different kind of adventure.

It started uneventfully.We decided to take a trip to the western province to check out Lake
Kivu, a pristine freshwater lake nestled between northwestern Rwanda and
eastern Congo.We set out Saturday
morning by bus and arrived before 4pm at Home St. Jean, a beautiful little hostel
overlooking the lake. For $14 each, we got clean rooms for the night with
private toilets, hot showers and complimentary soap. The restaurant service was
a little slow, but otherwise we had no complaints.We had found heaven on earth for an obscenely
reasonable price.

The next morning we took a boat to Amahoro Island and back
before hopping a bus to Kigali. We were dusty and tired, but happy.We settled in for the three-hour ride home.

Then, about an hour into our trip, the bus stalled and steam
started gushing from under the hood. No one seemed perturbed – breakdowns happen
often in Rwanda.The driver pulled over
and hopped out to inspect the damage while passengers dug out their cell phones to let their friends and family know about the delay. The
driver had his phone out too, and I assumed he was calling another vehicle to
come pick us up – until I heard him say, “Urazanye amazi!” Bring water?Really? He expected us to make it to Kigali with
a busted radiator? I started to ask the people around me if this really was the
plan.Meanwhile, the driver was poking
the floor with a stick and steam had started to fill the front end of the bus,
slowly at first, and then…

BOOM. Something burst, and a brownish jet of hot water shot
up through the floor. A woman screamed, and suddenly
there was mass panic.Passengers started
shoving each other to the ground in an effort to get out the door. I tossed my
backpack out the window and started trying to climb out after it, but my shirt
snagged on something and I left dangling halfway out the window screaming “STOP
STOP STOP” while people shoved me from behind. Kristina was in the back of the
bus with her hands over her head. Tiffany leapt out a window on the other side.
Bromley, the only sane one among us, had recovered Tiffany’s iPhone before
making her way calmly out the side door. I think everyone – myself included –
had assumed the whole bus was going to blow.

When the dust cleared, it became apparent that the panic was
causeless.I don’t know enough about
buses to explain the jet of water (respond in the comments section, please?)
but it turned out that all the driver needed to do was release some pressure
that had built up in the cooling system and send for a jerry can to replenish
the water that was lost. Less than an hour later, we were all back in the bus
and headed home.We made it to Kigali without
further incident.

Back at the house we recounted what happened to Eli and
laughed until we cried.I really couldn’t
have asked for better travel companions.A lesser group would take a break from weekend travel, but not us.We’re already gearing up for our next
adventure.

Tuesday, June 9, 2015

I’ve been trying for a couple of weeks now to write a compelling
post about working for an international nonprofit. The issue isn't that I don't have material; our data speak volumes about peoples' lives here, and every single thing we collect - every survey, every blood sample - tells a unique and often harrowing story. In the questionnaires alone, we can see stories of young couples struggling to make ends meet, couples who walk an hour or more to get to a clinic that provides family planning services, who are raising small children and holding down multiple jobs despite being sick with HIV. In the data we can see stories of thirty-year relationships potentially ruined by infidelity, but more often than that, we see stories of couples who dutifully get tested for HIV on a regular basis, perhaps even annually, but forgo modern contraceptives. I want to talk about individual stories that have emerged from the surveys and lab but I don't want to publicly reveal too much about our research. Sometimes I also struggle to capture raw feelings and thoughts when I'm writing after sending a series of work emails. But I will continue to post, and hopefully some of it will be worth reading.

If there’s one insight worth sharing from the past three
weeks, it’s that international nonprofit work and Peace Corps Service aren’t as
different as one might think. Projet San Francisco is exceptionally well-organized
for an operation its size - internally it is a well-oiled machine - but it is still subject to all the same infrastructural
shortcomings and administrative inefficiencies as every other Kigali-based
organization. Sometimes the power cuts out. Sometimes the internet doesn’t
work. Sometimes things don’t happen on schedule. Sometimes surveys collected
from the clinics are missing essential information because everything is
painstakingly recorded by hand in multiple languages. Most of the time, things
work quite well, and it’s nothing short of miraculous.

This week I will be helping develop a plan for study enrollment. I will be working with Robertine, a formidable woman with such a breadth of responsibilities at PSF, I'm not sure of her job title. She is primarily responsible for working with the nurses who provide couples' counseling and contraceptive promotion services at different clinics. Her counterpart is Jeannine, who basically runs the administrative office and ensures that data collection goes smoothly. I'm excited to spend more time with them in the coming weeks. Not only are they incredible at what they do, but they are some of the kindest people I've ever had the privilege of meeting.

Monday, May 25, 2015

I visited my old Peace Corps site over the weekend.I took a twegerane to Nyabugogo, Kigali’s
main bus park, and bought a ticket for a southbound bus.As I boarded, three different scenarios ran
through my head.I’d show up and the
whole village would look different, no one I knew would live there anymore, the
Peace Corps would have discontinued my site and the whole visit would be
nightmarish and disorienting.Or I’d
show up and things would be even more beautiful than I remembered, I would be
welcomed with open arms, an impromptu celebration would be thrown in my honor,
tears of joy would be shed, the new PCV would be beside herself to meet
Gihara’s inaugural volunteer.Or I’d
show up and it would be as if I’d never left. I put in my headphones and
watched a familiar stretch of countryside swish past, my heart pounding in my
throat.

When I arrived, the reality I found was mixed.The village was largely unchanged.It was market day, and the same vendors who
used to sell me fruits and vegetables had laid out their usual spread.People waved to me and called my name as if
I’d returned from a weekend vacation.I
found a new storefront had emerged among the tea shops.A giant icon of Jesus had been erected in
front of the convent where I used to live – so huge, I thought for a horrifying
moment that the convent was gone – but when I rounded the corner, the familiar
green gate was still standing.

The nuns I used to live with were no longer there.New faces had taken their place.Sister Donatile and Sister Amarita have been
permanently relocated to some other country – the Central African Republic, if
I understood correctly – by some authority in the diocese. Sister Mediatrice
left Gihara to pursue a degree.Sister
Marie Rose is still based in Gihara, but she was gone for the weekend.I was still greeted warmly and invited to
have lunch at the convent, but I felt a little like I’d come home from summer
camp to an empty house.

Leaving the convent, I wandered off into the hills to look
for familiar faces. My goal was to find Annoncée’s house.I’d been there so many times I was sure I
could find the road, but new houses had sprung up all over my route and I got
thoroughly lost.I fell back on a
village habit and started asking all the children I encountered if they knew
Umwarimu Annoncée, eventually gathering a sizeable party.So it was that I and about half a dozen
children showed up in her front yard.

Before I had time to wonder if she’d remember me, she ran
outside and threw her arms around me, literally lifting me up into the air. She said, “Long time!” Finally, someone who
felt the same way I did.I asked her
about the school where we used to teach together.Apparently Peace Corps discontinued the site –
the school has not received any new volunteers.My former students are now in their final year of secondary.Otherwise, things are unchanged.

I left Gihara feeling dusty and exhausted.Back in the capital, I’m scrolling through
the phone numbers I’ve amassed.I didn’t
find Louise, my best Gihara friend, nor did I find her number.I have a few phone numbers for people who
might be able to find her, though.I’m
thinking this is how I’m going to spend my weekends – tracking down old
friends.

Outside, rain is pounding the walls of the house.It makes me think of the dry season and how
unsettled I would get when the rain tankard ran low.It would get so dry that honey bees would
gather around the spigot searching for droplets.I always wondered what would happen if the
water ran out completely, but I never got a chance to find out.Just when things would start to seem desperate,
the sky would open up like a tap and release a deafening torrent.Rain would hammer the tin roofs and flood the
gutters.Every time, it felt like a
prayer miraculously answered.Rain still
sounds like that to me – like a gift from God.

For the first time since the plane touched down, I feel a
sense of relief.

Friday, May 22, 2015

Muraho bose! I’m reviving my Peace Corps blog to bring you
more stories from Rwanda.As of my last
post, I had just returned home to California.I had begun studying for the GRE and initiated the long process of
cultural reintegration.I remember
feeling good, if a little unsteady.

A lot has happened since then.Two jobs, one volunteering stint with Planned
Parenthood, six master’s program applications, five acceptances and one year of
grad school later, I have returned to Rwanda to begin a summer internship with
the Rwanda Zambia HIV Research Group (an awesome organization – read more about
them here).I will be conducting
research to improve the provision of long-acting reversible contraceptives to
couples who do not want more children, or who want to wait at least three years
to have more children.In a country as
densely populated as Rwanda – to the extent that arable farmland here literally
cannot produce enough food to support the existing population – modern
contraceptives are extremely important.Long-acting reversible contraceptives are great because they’re
effective even in the event of a supply chain interruption.* I’m so happy to be
here. I’ve been hoping to do exactly this kind of work ever since I found a
copy of Half the Sky lying around the Peace Corps office in Kigali.I never dreamt I’d end up returning to Rwanda
for this, but here I am.

Nothing is ever quite as expected.I thought landing in Kigali would be an
adrenaline rush, but something even more unsettling happened. When we touched down, I looked out the window
and thought, “Oh good.I’m finally home.”

*Oral contraceptives and
injectables, though popular in Rwanda, are less effective than long-term reversible
contraceptives simply because they have to be used on a regular basis.If a clinic runs out of IUDs, the women
currently using them won’t have any problems, but if a clinic runs out of birth
control pills, it’s a whole different story.